{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:48:45Z","timestamp":1782200925008,"version":"3.54.5"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UID\/04279\/2025"],"award-info":[{"award-number":["UID\/04279\/2025"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Accurate chronic wound classification is essential for appropriate management, yet diagnostic variability persists in routine practice. Transparent, rule\u2010based decision\u2010support tools may improve standardisation but require validation against expert judgement under clearly defined conditions. To evaluate inter\u2010expert agreement, agreement between a rule\u2010based algorithm and an expert\u2010consensus reference standard, diagnostic accuracy as a complementary measure, exploratory comparison with a non\u2010expert nurse, and expert agreement with algorithm\u2010generated therapeutic recommendations. Thirty anonymised standardised clinical cases were classified by the algorithm and one non\u2010expert nurse. Thirty wound\u2010care experts, including 26 nurses, three physicians, and one researcher, were organised into six independent panels of five and classified case subsets, yielding 150 ratings. A consensus reference diagnosis was defined a priori as agreement by at least 3\/5 experts. The primary outcome was algorithm\u2013consensus agreement using Cohen's\n                    <jats:italic>\u03ba<\/jats:italic>\n                    . Expert reliability was assessed using Krippendorff's\n                    <jats:italic>\u03b1<\/jats:italic>\n                    and Fleiss'\n                    <jats:italic>\u03ba<\/jats:italic>\n                    . Recommendation agreement was dichotomised and analysed exploratorily. Expert agreement was low to moderate (Krippendorff's\n                    <jats:italic>\u03b1<\/jats:italic>\n                    \u2009=\u20090.26\u20130.60), highest for pressure ulcers\/injuries and venous leg ulcers, and lowest for mixed or unknown leg ulcers and diabetic foot ulcers. Consensus was reached in 29 of 30 cases. The algorithm achieved 86.2% accuracy (25\/29) and substantial agreement (\n                    <jats:italic>\u03ba<\/jats:italic>\n                    \u2009=\u20090.70, 95% CI 0.46\u20130.94). Nurse accuracy was 72.4% (21\/29,\n                    <jats:italic>p\u2009=\u20090.219<\/jats:italic>\n                    ). Experts endorsed 85.2% of therapeutic recommendations. The algorithm showed promising agreement under controlled conditions, supporting further prospective validation in larger, balanced real\u2010world datasets.\n                  <\/jats:p>","DOI":"10.1111\/iwj.70952","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T01:50:36Z","timestamp":1781056236000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of a Clinical Decision\u2010Support Algorithm for Chronic Wound Classification and Treatment: An Expert Consensus"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6701-3530","authenticated-orcid":false,"given":"Raquel","family":"Marques","sequence":"first","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, Centre for Interdisciplinary Research in Health Universidade Cat\u00f3lica Portuguesa  Porto Portugal"},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, School of Nursing Department Universidade Cat\u00f3lica Portuguesa  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9262-0375","authenticated-orcid":false,"given":"Carla","family":"Pais\u2010Vieira","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, Centre for Interdisciplinary Research in Health Universidade Cat\u00f3lica Portuguesa  Porto Portugal"},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, School of Nursing Department Universidade Cat\u00f3lica Portuguesa  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-8023","authenticated-orcid":false,"given":"Marcos","family":"Lopes","sequence":"additional","affiliation":[{"name":"School of Nursing Department Universidade Federal Cear\u00e1  Fortaleza Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5330-779X","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Neves\u2010Amado","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, Centre for Interdisciplinary Research in Health Universidade Cat\u00f3lica Portuguesa  Porto Portugal"},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, School of Nursing Department Universidade Cat\u00f3lica Portuguesa  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6348-3316","authenticated-orcid":false,"given":"Paulo","family":"Alves","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, Centre for Interdisciplinary Research in Health Universidade Cat\u00f3lica Portuguesa  Porto Portugal"},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem, School of Nursing Department Universidade Cat\u00f3lica Portuguesa  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12683"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2018.10.005"},{"key":"e_1_2_11_4_1","volume-title":"Prevention and Treatment of Pressure Ulcers\/Injuries: Clinical Practice Guideline. The International Guideline","author":"European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance","year":"2019"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3657"},{"key":"e_1_2_11_6_1","volume-title":"Best Practice Statement: Primary and Secondary Prevention in Lower Leg Wounds","author":"Wounds UK","year":"2024"},{"issue":"4","key":"e_1_2_11_7_1","first-page":"46","article-title":"A Cross\u2010Sectional Study to Validate Wound Care Algorithms for Use by Registered Nurses","volume":"56","author":"Beitz J. 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In: Official Journal of the European Union \u201d(2024) https:\/\/eur\u2010lex.europa.eu\/legal\u2010content\/EN\/TXT\/PDF\/?uri=OJ:L_202401689."},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/WON.0b013e3182383f07"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/informatics4030020"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010025\u201003626\u20106"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.1.102803.143810"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010020\u201001095\u20108"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001531"},{"key":"e_1_2_11_24_1","volume-title":"Computing Krippendorff's Alpha\u2010Reliability","author":"krippendorff k.","year":"2011"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102648.2007.04474.x"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2006.06.006"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vasdi.2025.04.001"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12429"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181c30fb2"},{"key":"e_1_2_11_30_1","unstructured":"World Health Organization \u201cEthics and Governance of Artificial Intelligence for Health: WHO Guidance \u201d(2021) https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/f780d926\u20104ae3\u201042ce\u2010a6d6\u2010e898a5562621\/content."},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70064"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2021.104536"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010020\u201078799\u2010w"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746\u2010020\u201000367\u20103"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/hast.973"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102022\u2010070904"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASW.0000852564.21370.a4"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70952","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.70952","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70952","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:20:52Z","timestamp":1782199252000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.70952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/iwj.70952"],"URL":"https:\/\/doi.org\/10.1111\/iwj.70952","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70952"}}